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Royal Commission into Victoria’s Mental Health System

Case study:

The Child and Family Health Service at Barwon Health North

In September 2020, Barwon Health established the Child and Family Health Service at the newly built community health facility in North Geelong. The service is designed to help children from before birth to preschool with developmental delays and vulnerabilities. Unlike similar developmental paediatric services around Australia, psychiatry is formally included within the multidisciplinary team.

Dr Ben Goodfellow, Perinatal, Infant and Child Psychiatrist and Psychoanalyst at the service, noted the importance of embedding mental health services in paediatric care.

For several decades there have been many barriers to helping families who could benefit from what infant mental health has to offer—firstly, a lack of experienced infant mental health clinicians and services, but also the very siloed nature of health services. The integration of care that comes from being directly in the paediatric setting provides the opportunity to treat, teach and guide practice that colleagues from all health disciplines in my field have been advocating for.

Dr Goodfellow observed that while youth mental health services have grown, many obstacles to young children receiving treatment remain.

From the perinatal period to preschool, children and families are often unable to access specialist mental health care, not only because of scarce resources, but also because of a lack of awareness and understanding in the broader community, that babies and young children can be engaged in mental health treatment no less than people of any other age. Importantly, mental health problems in young children so often present with physical symptoms, and so the system stays focused on a medical solution, when in fact the mind and body are very much intertwined but require different expertise.

Dr Goodfellow said the Child and Family Health Service’s integrated approach enables it to address the multiple determinants of a child’s wellbeing.

The integrated design recognises the powerful connections between the social, emotional and family determinants of a child’s development, health and wellbeing. It unifies support for the psychic, relationship‑based, and physical needs of babies and children by working with families where they are at, while keeping the baby or child in mind as a person in their own right and at the centre of care.

Embedding psychiatry in the multidisciplinary team assists in breaking down some of the most common barriers to comprehensive, integrated care. Paediatrician and director of the service, Dr Chris Cooper, spoke of the benefits of working closely with colleagues from other disciplines.

I learn so much from working alongside my child psychiatry colleague in real‑time. Child psychiatry’s involvement in community paediatrics should be ‘business as usual’ not an occasional extravagance.

One of the service’s speech pathologists explained how having a connection to psychiatry can assist in providing better treatment and support.

I’ve often recognised that the feeding problems in infants I see is about much more than just the mechanics of it all. Now, through discussions with the psychiatrist, I’m learning how to include the family’s background story and their mental health in my understanding and treatment.

Referrals to the service can come from primary, secondary or tertiary providers, childcare centres and directly from families themselves, ensuring ease of access.

From a total staff of around 14 fulltime employees, the formal mental health component of the service includes a perinatal, infant and child psychiatrist one and a half days per week, and two child psychologists. Other medical and allied disciplines are supported closely in the mental health elements of their work. Dr Goodfellow said:

The integration allows for a shared approach to case planning, decision making, governance and clinical supervision. This includes oversight from senior clinicians, and the ability for more complex cases to receive direct and indirect input from psychiatry. This rolling process of professional development sees clinicians expanding their understanding and ways of working beyond the expertise of their primary discipline, with increasing sophistication in the therapeutic, psychosocial and parent‑guidance elements of their work. It’s very inspiring to see.

Founding principles of the service include making those children most in need—such as those in and out of home care and others known to be at high risk for treatable developmental delays—a priority and working in community settings where possible. Concepts of the ‘First 1000 Days Program’ inform much of the clinic’s work, recognising that a child needs coordinated networks of love, care, learning, support and clinical treatment to flourish.

Pending positive evaluations of the Child and Family Health Service’s models of care and effectiveness, Barwon Health plans to expand it across its entire service area.

Source: Dr Ben Goodfellow, Correspondence to the RCVMHS, 2020.